Can trazodone (antidepressant medication) lower milk supply in lactating women?

Can Trazodone Lower Milk Supply?

No, trazodone does not lower milk supply in lactating women. The FDA label explicitly states there are no data on the effect of trazodone on milk production, and available evidence shows only minimal transfer into breast milk without documented effects on lactation 1.

Evidence Supporting Safety for Milk Production

FDA Position on Milk Supply

• The FDA drug label clearly documents that "there are no data on the effect of trazodone on milk production," meaning no evidence exists that it reduces supply 1
• Limited postmarketing reports have not identified adverse effects on breastfed children, which would include feeding difficulties from inadequate supply 1

Pharmacokinetic Profile Supports Minimal Impact

• Trazodone has a very low milk/plasma ratio of 0.142, meaning minimal drug transfer into breast milk 2
• Infant exposure through breast milk is extremely small: less than 0.005 mg/kg compared to maternal dose of 0.77 mg/kg 2
• A case study confirmed trazodone concentration in breast milk was only 50.2 ng/mL (with metabolite at 3.2 ng/mL), with no adverse effects observed in the infant at 1-, 3-, and 6-month follow-ups 3

Clinical Recommendations

Trazodone Can Be Used During Breastfeeding

• Trazodone is compatible with breastfeeding based on its pharmacokinetic profile and clinical experience 4
• The developmental and health benefits of breastfeeding should be weighed against the mother's clinical need for trazodone, but milk supply concerns should not factor into this decision 1

Contrast with Medications That DO Affect Supply

• Stimulant medications (e.g., for ADHD) may actually decrease milk supply and should be avoided if supply is a concern 5
• Clonidine may reduce prolactin secretion and could conceivably reduce milk production in the early postpartum period 6
• Dopamine agonists would theoretically suppress prolactin and reduce supply, but trazodone does not have this mechanism of action

Common Pitfall to Avoid

• Do not confuse trazodone with medications that genuinely affect milk supply through prolactin suppression 6, 5
• If a breastfeeding mother on trazodone experiences low milk supply, investigate other causes (inadequate frequency of feeding/pumping, poor latch, thyroid dysfunction, retained placental fragments) rather than attributing it to the medication 7, 8

Monitoring Recommendations

• While trazodone does not affect milk supply, monitor the infant for sedation or drowsiness, as trazodone does transfer into breast milk in small amounts 1, 3
• Ensure the mother takes trazodone before the infant's longest sleep interval to minimize infant exposure 5